Senegal on the frontline of the battle with Big Tobacco

Djité Sekou, 32, smokes as he passes his nights guarding one of the many high-rise apartment buildings in Dakar, Senegal. It has been eight years since his first cigarette - a Monte Carlo from Morocco - and when money is available he goes through 20 to 30 per day. It is an addiction that can cost him up to a quarter of his monthly income.

Like most smokers in Senegal, he rarely buys a full packet, preferring to purchase cigarettes individually - a sales strategy tobacco companies employ to ensure that even those with limited means are able to afford their daily nicotine.

Sekou is one of a growing number of smokers across Africa. While reliable, up-to-date figures are unavailable, the 2007 Global Youth Tobacco Survey estimated that up to 20 percent of Senegalese boys and 10 percent of girls aged 13 to 15 used tobacco products - a number believed to be much higher today.

Oumar Ndao, Senegal’s focal point for tobacco control at the Ministry of Health, says, “This is due to extremely weak legislation that, apart from prohibiting television advertising, demands no restrictions.”

Tih Ntiabang, Africa coordinator of the civil society Framework Convention Alliance, based in Yaounde, Cameroon, says advertising focuses “on two groups of people - the youth and women. For the youth, they portray smoking as cool. For women, if you smoke you are emancipated.”

In Senegal, there are almost no restrictions on smoking in public places, and warning labels on packets are small.

The exception is the holy city of Touba, where smoking has been banned for religious reasons since 1980 (15 years before the US State of California enacted its ban on smoking in enclosed workplaces).

Yet with Senegal’s parliament due to vote on new anti-smoking legislation, the rest of the country may soon follow suit.

If passed, the law would ban all tobacco advertising, restrict smoking in public places, and demand health warnings that cover 30 percent of all cigarette packaging.

Ndao believes that, even if the law could be strengthened further, this would be a “major step forward” and “endow Senegal with one of the strongest [such] laws in the region.”

Weak tobacco control continent-wide

With the largest proportion of young non-smokers and the weakest tobacco controls of any other continent, according to the World Health Organization (WHO), Africa is a lucrative market for cigarette marketers.

Just five African countries have comprehensively banned smoking in public places, according to WHO, while nine - Chad, Eritrea, Ghana, Guinea, Kenya, Madagascar, Mauritius, Niger and Togo - ban all tobacco advertising. Only four African countries - Madagascar, Mauritius, Niger and the Seychelles - meet WHO recommendations for health warnings on packaging.

“In a number of places, there is no legislation at all,” said Ntiabang. “What is really driving this is the tobacco industry strategy to recruit new smokers.”

Yet even where laws do exist, enforcement is a major problem. Senegal’s Ministry of Health has banned smoking in all health centres, but according to the government’s own report to WHO, this has had “no practical impact in reality.”

WHO estimates that, globally, tobacco kills six million people per year, a figure that, without action, could rise to eight million by 2030, with 80 percent of deaths occurring in low- and middle-income countries.

Taking on the tobacco industry

Many health advocates believe the tide is turning, however, with Kenya, Mauritius, Seychelles and South Africa all having introduced tighter tobacco control laws in recent years. Ntiabang believes these are symptoms of “a changing trend” - but one under threat by the tobacco industry.

The 2013 WHO global report on tobacco use accuses the industry of trying to influence public health policy, exaggerating its economic importance, manipulating public opinion, fabricating support from “front groups”, undermining proven science and intimidating governments with litigation.

“Tobacco industry interference is the number one problem we have in Africa, especially in countries that are in the process of elaborating legislation,” Ntiabang adds. “The tobacco industry interferes in every single stage of this process.”

A WHO official IRIN interviewed agreed: “Every single country in Africa where there is proposed legislation, you find them there.”

According to Article 5.3 of the WHO’s Framework Convention on Tobacco Control, tobacco companies are not supposed to be involved in shaping health policy. But the official said many countries have been swayed by “information given by the industry claiming that they are critical to the economy, and yet the reality is they are just profiteers and are not contributing that much to the economy.”

Senegal has been no exception, says Ndao: “The industry managed to infiltrate the process with strong lobbying of decision-makers.”

In Senegal, industry officials lobbied to soften the total ban on advertising to allow communications at the point of sale, but the government has not ceded. They also pressed to ensure health warnings need not be in picture form, said Ndao, which has been more successful. But the [Senegalese] authorities are trying to resist industry pressure and are “aligned strongly with the WHO Convention” he told IRIN.

A spokesperson for Philip Morris, which controls over 40 percent of the tobacco market in Senegal and owns a cigarette factory in Dakar, confirmed that the company has “proactively and transparently” been communicating its opinions to government, “like any other industry”.

"The [tobacco] industry is losing major markets in Europe and North America, and is seeking refuge in Africa"

While the company “welcomes the proposal for the implementation of a tobacco-control law in Senegal”, it continues to seek amendments to “a few elements” including “the lack of a transition period, the ban on trade incentives for wholesalers and retailers, and the total ban on advertising.”

To Ndao, the incentive is clear: “The industry is losing major markets in Europe and North America, and is seeking refuge in Africa, which explains their strong presence in Senegal.”

Health impact

Ahmadou Dem, surgical oncologist at Joliot Curie Cancer Institute at the Dantec hospital in Dakar, is already seeing the consequences of smoking. He has noted an increase in cancers of the lung, larynx, pharynx, bladder and pancreas.

If nothing is done, the future could be more worrying still, he said. “It will be a catastrophe for our country’s health and economy, because our human and financial resources are limited and cancer care is costly.”

Dem adds that while facilities to treat cancer do exist - offering surgery, radiation therapy and chemo therapy - they remain “largely inaccessible for the majority of patients, who are poor”.

Any efforts to reduce smoking rates in Senegal must include an “ongoing anti-smoking campaign at schools, in businesses, and in the media,” he told IRIN.

Weakening the law

Ndao recognizes that, despite the huge public health improvements the law will bring, there is a lot more work to do.

Unless amended by members of the National Assembly, smoking areas will still be permitted in restaurants, bars and hotels, and pictures warnings - considered essential in a country where half of the adult population is illiterate - will be voluntary. Ndao believes parliamentarians will strengthen these areas of the law before it passes.

And the law will not undertake what is commonly regarded as the most effective way of reducing smoking - raising the price of cigarettes. Such a measure has to be dealt with separately through the tax system.

At just $0.80 a packet for an economy brand, and $1.20 for a premium brand, cigarette prices in Senegal are almost 10 times cheaper than in the UK and among the cheapest in the world.

Senegal has chosen not to follow the Economic Community Of West African States guidelines allowing countries to tax cigarettes up to 150 percent, instead abiding by the West Africa Economic and Monetary Union rules limiting taxes to just 45 percent.

According to WHO, a 10 percent price increase for tobacco products reduces consumption by 8 percent in low- and middle-income countries.

Two years ago, Phillip Morris created a national scandal in Senegal by reducing the price of its Marlboros by one-third. Black market cigarettes from neighbouring countries such as Gambia and Guinea-Bissau also push prices down.

Sekou believes that both a stronger law and higher taxes are “necessary,” especially for smokers like himself. “Senegal has the right to do it. Everyone wants to quit. The more they smoke, the less they eat,” he said.

“For me, someone who struggles to get 1,000 CFA [$2.00] per day, if the price went up - and my wife is next to me, my son is next to me - I wouldn’t do it,” he continued. “Even today paying $1.20 [for a packet] is a problem.

“As of today, I have decided to quit. I got myself into it, and I’ll get myself out of it too.”